Anterior Abdominal Wall Necrotizing Fasciitis Following Laparoscopic Sleeve Gastrectomy With Hiatal Hernia Repair: A Case Report

Necrotizing fasciitis (NF), commonly known as necrotizing soft tissue infection (NSTI), or flesh-eating disease is a rare but rapidly fatal aggressive bacterial infection of soft tissue and deep skin that results in the destruction of the underlying fascia. Symptoms include fever, tachycardia, hypotension, leukocytosis, pain, and large areas of red and swollen skin. Early diagnosis and aggressive management are compulsory for a better prognosis. In this case report, we present a 58-year-old obese woman who initially presented to the emergency department three weeks post-sleeve gastrectomy with hernia repair and was initially suspected of having a large, uncomplicated abdominal wall abscess. Several repeated drainages of the abdominal wall abscess and continued deterioration of the patient revealed foul-smelling, necrotic tissue and the subsequent diagnosis of NF. This case report highlights the importance of high clinical suspicion for NF and early, aggressive debridement and treatment to improve patient outcomes.